J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 10;9(12). doi: 10.5435/JAAOSGlobal-D-25-00037. eCollection 2025 Dec 1.
ABSTRACT
INTRODUCTION: Interspinous process devices (IPDs) are a lesser invasive treatment option for lumbar spinal stenosis (LSS). The utility of IPDs has been debated, and no recent, large-scale representative database studies have examined utilization and revision surgery trends of IPDs.
METHODS: Patients with LSS undergoing IPD placement were identified from the 2017-2022 M170Ortho PearlDiver Database and stratified by direct lumbar decompression usage and levels treated. Yearly IPD utilization of the study populations was tracked, and notable changes in usage were identified. Provider specialties placing IPDs were assessed. Kaplan-Meier survival analyses followed 3-year subsequent lumbar operation rates.
RESULTS: A total of 10,422 patients with LSS undergoing IPD placements were identified, with a significant utilization increase from 2017 to 2020 (P = 0.027) and decrease from 2020 to 2022 (P = 0.039). These were done without direct decompression for 6183 (59.3%) and with direct decompression for 4239 (40.7%), with greater proportion performed without decompression over the years (P = 0.032). One-level procedures were 6,723 (64.5%) and two-level procedures were 3,699 (35.5%), with similar proportions over the years. Orthopaedic/neurologic surgeon utilization decreased, with pain specialists becoming the predominant providers using IPDs. Overall 3-year revision surgery rate was 12.0%, and no differences existed in revision surgery rates by decompression usage (P = 0.2) or levels treated (P = 0.3).
DISCUSSION: This study is first to report on the notable IPD utilization decrease from 2020 to 2022 after strong adoption from 2017 to 2020. This aligned with an increasing proportion placed without decompression and by pain specialists, with no revision surgery rate differences. Although the reason for this change over time is unclear, this study reports shifting physician practices with IPDs.
PMID:41380147 | DOI:10.5435/JAAOSGlobal-D-25-00037
